Advocacy & Compliance

Healthesystems’ Advocacy & Compliance experts are essential in the management of pharmacy and ancillary benefits for our clients. By tracking and influencing regulatory activity, our team stays ahead of evolving trends and identifies opportunities to advocate on behalf of our clients, their injured workers, and the broader industry.

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The Advocacy &  Compliance Team

Monitors and reports on proposed and pending regulatory changes that impact workers' comp, helping shape effective program strategies

Advocates for fair and balanced public policy through proactive engagement with regulators, customers, and other stakeholders throughout the rulemaking lifecycle

Supports operational compliance by providing guidance to internal stakeholders and external partners during the implementation of new regulatory changes

Regulatory Recap

A weekly e-newsletter informed by the Advocacy & Compliance team to help keep our clients and industry contacts in the know on the latest legislation and policy updates impacting workers’ comp.

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Cost Containment

CMS Publishes 2025 Q4 NCCI Edit Updates

The changes are effective October 1, replacing the 2025 Q3 versions.

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September 8, 2025

Advocacy Opportunity Billing & Payments

Ohio BWC to Refile Outpatient Medication Rules

The BWC withdrew its proposed outpatient medication reimbursement rules for self-insured employer claims due to a technical error.

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September 8, 2025

Cost Containment

NCCI Publishes New Research Brief on Medical Fee Schedules

The report reviews how changes to CMS reimbursement rules may impact medical costs in workers’ comp.

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September 1, 2025

Worker Safety

CPWR Publishes Report on Heat Injuries and Illness Among Construction Workers

While construction workers make up only 7% of the workforce, they account for more than one-third of occupational heat-related deaths in the U.S.

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September 1, 2025

Mental Health Presumptions

New Jersey Now Requires Counseling for First Responders After Traumatic Incidents

Effective immediately, workers’ comp programs are required to pay for up to 12 hours of counseling following critical incidents.

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September 1, 2025

Advocacy Opportunity Treatment Guidelines

California Proposes Updates to Medical Treatment Utilization Schedule

Public comments can be made on the proposed changes until September 26th, at which point a hearing will be held.

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September 1, 2025

Advocacy Opportunity Cost Containment

Tennessee Medical Payments Committee Meeting Highlights

Discussions centered around the proposed medical fee schedule, particularly the Medicare negotiated pricing for pharmaceuticals.

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September 1, 2025

Cyber Risk Technology

Wisedocs Publishes Survey Report on AI In Claims

Over 65 claims professionals were surveyed on their thoughts surrounding AI in the insurance industry.

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August 25, 2025

Opioids

FDA Orders Opioid Manufacturers to Update Prescribing Information for Long-Term Use

Labeling changes must address safety considerations including the limited use of extended-release formulations, safe discontinuation, and more.

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August 25, 2025

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Further resources you may be interested in

Additional articles and updates from Healthesystems related to policy shaping workers’ comp.

Extreme Weather: How Climate Change Impacts Workers and Workers’ Compensation

While everyone is affected by climate change, it’s often those on the front lines who feel it the most – those who work outdoors, in hot indoor environments, or in emergency response.